| NPI | 1710114459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3421) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-006532L) |
| 207Q00000X Family Medicine (Licence: FL OS-5581) | |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2011-04-04 |